Portable ECG device with wireless communication interface to remotely monitor patients and method of use

ABSTRACT

A portable ECG monitor and an overall system for remotely monitoring cardiac function of a patient is disclosed, together with a method of use. The portable ECG includes a multi-lead, multi-channel ECG monitor and a wireless communication device connected to the ECG monitor to receive patient ECG data and transmit the patient ECG data to a centralized facility, such as a hospital. The wireless communication device can include a mobile phone and/or an interactive Internet appliance. A method of remotely monitoring ECG data is also disclosed. The method and apparatus are particularly useful with patients experiencing symptomatic ischemia. The method includes providing a portable ECG device with wireless communication capabilities to such a patient, acquiring ECG data from the patient at a location remote from a health care facility, then transmitting the ECG data to the centralized facility, and assessing the ECG data at the centralized facility. The patient is then provided with instructions based on the ECG assessment. The centralized facility and the health care facility may be one in the same, or may be two different and distinct facilities.

BACKGROUND OF THE INVENTION

The invention relates generally to electrocardiograms (ECGs) and the usethereof, and more particularly to, a method and apparatus to remotelymonitor patients using a portable ECG device with a wirelesscommunication interface.

ECG analysis is a well established method for studying the function ofthe heart and identifying disorders of the heart. An ECG is a graphictracing of the variations and the electrical potential caused by theexcitation of the heart muscle as detected at the body surface by theleads of the ECG device. A normal electrocardiogram is a scale orrepresentation that shows deflections resulting from cardiac activity aschanges in the magnitude of voltage and polarity over time and includesa P-Wave, a QRS complex, a T-Wave, and a U-Wave. These waves are thenanalyzed using a set of rules and parameters to determine what is normaland what is not. Certain deviations are used to flag possiblecomplications.

ECG is an important tool in diagnosing patients presented to anemergency room with chest pain. One particular disorder that is studiedusing ECG is acute cardiac syndromes (ACS), which includes, but is notlimited to, acute myocardial infarction (AMI) and acute cardiac ischemia(ACI), the latter of which is commonly referred to as unstable angina.Acute ischemia, or unstable angina, includes the starvation of oxygen toa portion of the heart, commonly caused by a partial blockage, and acuteinfarction is the complete blockage of oxygen to a portion of the heart.Ischemia can lead to or be a symptom of myocardial infarction. It iswell known that time is critical in diagnosing these conditions in apatient experiencing chest pain.

Unstable angina, or ischemia, is sometimes difficult to diagnose anddifferentiate from other causes of chest pain which are not lifethreatening. However, since ischemia can lead to AMI, and since time totreatment is critical once AMI sets in, it is advantageous to properlydiagnose an ischemic patient as soon as possible. For example, once AMIsets in, the benefit of applying treatment is reduced significantly whenthe elapsed time from the onset of AMI chest pain to treatment exceedssix hours. Unfortunately, patients often delay in seeking treatment whenthey first experience chest pain, which compromises the opportunity thatexists for salvaging the heart muscles affected via treatment, such asthrombolytic therapy. Further exasperating this problem, studies haveshown that patients who are under the care of a physician, and/or havepreviously experienced AMI, delay the most in seeking care. This may bedue to the fact that the patients do not wish to “bother” the physicianfor “mild” pain. It may also be due to the fact that the patients mayhave had false alarms in the past that resulted in a long wait at thehospital.

It would therefore be advantageous if a physician, or health careprovider, could supply a device to this type of patient that couldexpedite diagnosis and treatment by alleviating the embarrassment andtime expense of showing up in an emergency department when in fact, nocardiac problem exists. This could eliminate not only the time involvedin a patient going to the emergency room for indigestion, but also saveshospital resources and health insurance costs.

SUMMARY OF THE INVENTION

A method and apparatus is disclosed to remotely monitor ECG data from apatient using a portable ECG device with a wireless communicationinterface that solves the aforementioned problems.

In general, the invention includes the use of a multi-lead,multi-channel ECG monitor that allows 24-hour surveillance by aqualified clinician at a central facility, or hospital, of a patientexperiencing symptomatic ischemia without requiring costlyhospitalization. The ECG monitor is coupled with a communications devicethat will automatically communicate with the centralized facility, whichmay be a hospital, or could be a separate facility providing aspecialized service to a hospital. To provide simplicity of use, thesystem should not require the patient to remember a phone number andrequire dialing the phone number when the patient is in the middle ofexperiencing chest pains, and preferably, there should be no extradevice to plug into a wall outlet which may be time-consuming anddifficult for some patients when experiencing ischemic symptoms.

Therefore, in accordance with one aspect of the invention, a portableECG apparatus is disclosed that includes an ECG monitor connected to aplurality of lead wires and a plurality of transducers, capable ofreceiving a plurality of ECG signals from the patient. The ECG wirelesscommunication device is coupled to receive patient ECG data from the ECGmonitor and transmit the patient ECG data to a health care provider. Thewireless communication interface can include a wireless mobile phonepreconfigured to communicate directly with the health care provider andtransmit voice and ECG data concurrently over a single connection. Audiocommunication will assist a clinician to ascertain the patient'ssymptoms and guide the patient in use of the device, if that isnecessary. Another implementation for the wireless communicationinterface includes the use of an Internet appliance which has infraredcommunication capability to communicate with the remote ECG monitor andtransmit data over the Internet. Transmission of ECG data then can alsoinclude video signals in addition to audio signals.

In accordance with another aspect of the invention, an ECG monitoringsystem is disclosed having a remote ECG monitor with multiple leads andmultiple channels to acquire ECG signals from the patient. A remotecommunication and interface is coupled to the remote ECG monitor toreceive the ECG signals from the remote ECG monitor and transmit the ECGsignals over a public communication system to a centralized facility. Alocal communication interface is provided to receive the ECG signalsfrom the public communications system at the centralized facility. Alocal ECG device is located in the centralized facility to connect tothe local communication interface and receive the ECG signals andprovide the ECG signals to a clinician or doctor in human discernableform.

In accordance with yet another aspect of the invention, a method ofremotely monitoring ECG data from a patient includes providing an ECGdevice to a patient experiencing symptomatic ischemia for use remotelyfrom a health care facility. The ECG device has communicationcapabilities to transmit ECG signals/data to a centralized facility. Themethod includes acquiring a multi-channel ECG from the patient at alocation remote from a health care facility, transmitting themulti-channel ECG to the centralized facility, and assessing themulti-channel ECG at the centralized facility by a trained clinician ora doctor. The method also includes providing instructions to the patientbased on the ECG assessment, which can include dispatching an ambulancein critical care situations. The method can also include offering remoteinteractive assistance in the use of the ECG device, if requested by thepatient. Additionally, the patient's location can be confirmed if thepatient becomes unconscious and the patient's exact location cannot beconfirmed through the remote communication interface.

Various other features, objects and advantages of the present inventionwill be made apparent from the following detailed description and thedrawings.

BRIEF DESCRIPTION OF THE DRAWINGS

The drawings illustrate one preferred embodiment presently contemplatedfor carrying out the invention.

In the drawings:

FIG. 1 is a block diagram of an electrocardiogram device incorporatingthe apparatus of the present invention.

FIG. 2 is a high level flow chart depicting an algorithm at leastpartially incorporated into the apparatus of FIG. 1 and showing themethod of the present invention.

FIG. 3 is a functional block diagram of one implementation of thepresent invention.

FIG. 4 is a functional block diagram of another implementation of thepresent invention.

FIG. 5 is a detailed flow chart of an algorithm programmed into theelectrocardiogram device of FIG. 1.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring to FIG. 1, an electrocardiograph device 10, in accordance withthe present invention, is shown optionally connected to an informationmanagement system 12 through a communications link 14. A commonly useddevice for acquiring an ECG is a 12-lead ECG, such as the GE MarquetteMacVu or Seer-MC equipped with 12SL™. The ECG device 10 and theinformation management system 12 receives power 16 from an externalsource. Among other things, the information management system 12includes a central processing unit 18 connected to a memory unit, ordatabase, 20 via a data link 22. The memory unit 20 may be RAM, ROM, amass storage unit, a floppy disk, or any other computer readable storagemedium, or a combination thereof. The CPU 18 processes data and isconnected to an output, such as printer 24 and/or display 26.Alternatively, the electrocardiograph 10 can be connected directly to aprinter 24 or display 26 through communications link 14 if the optionalinformation management system 12 is not utilized.

The ECG device 10 is connected to a plurality of patient lead wires 28,each having a transducer 30 to receive ECG signals from a patient 32 ina known manner. The ECG device 10 has a signal conditioner 34 thatreceives the ECG signals and filters noise, sets thresholds, segregatessignals, and provides the appropriate number of ECG signals for thenumber of leads 28 to an A/D converter 36 which converts the analogsignals to digital signals for processing by a microcontroller 38, orany other type of processing unit. Microcontroller 38 is connected to amemory unit 40, similar to memory unit 20, or any other computerreadable storage medium. In a preferred embodiment, memory unit 40 is acombination of ROM and RAM, wherein the ROM is used for static data,such as computer programs, and the RAM is used for dynamic data, such asthe ECG signals received from patient 32.

A power supply 42 is provided to supply isolated power 44 to the signalconditioner 34 and the A/D converter 36 and provide an isolation barrier46 to isolate the lead wires 28 from un-isolated power 48 and linevoltage 16. Such electrical isolation is typically provided by a medicalgrade isolation transformer, an optical device, or battery operation.

The ECG device 10 also includes a wireless communication device, such aswireless phone 50, which may be built into the ECG device 10, or may bean external module. The wireless phone 50 receives signals 52 from themicrocontroller 38 and is capable of transmitting voice and ECG data 54concurrently. The wireless phone 50 is powered by the uninsulated powersource 48. The wireless phone may be, what is commonly known as, acellular phone, a digital phone, or a multi-mode phone. ECG device 10can also include an interactive Internet appliance 56 connected to atelevision 58, to provide interactive audio and visual communicationwith patient 32. The ECG device 10 includes an infrared transmitter 60to communicate with an infrared receiver 62 of the Internet appliance56. The Internet appliance 56 is also equipped with an infraredtransmitter 64 to communicate with an infrared receiver 66 of the ECG10. Operation of this ECG monitor system will be further described withreference to FIGS. 2-5. Alternatively, the Internet appliance 56 andtelevision 58 can equivalently be integrated into a single unit or apersonal computer with an Internet connection could equivalently servethe function of an “Internet appliance.” Generally then, the “Internetappliance” is any device capable of transmitting such data over aninterconnected communication system, such as the Internet.

Referring now to FIG. 2, a high level flow chart of the process 100 anduse of a system incorporating the apparatus of FIG. 1 is shown. Theprocess 100 begins with providing an ECG device, such as that describedwith reference to FIG. 1, to a patient experiencing symptomatic ischemiafor use remotely from a health care facility 102. As will be describedwith further detail with reference to FIGS. 3 and 4, the ECG deviceincludes communication capabilities to transmit raw ECG signals, orprocess ECG data to a centralized facility. The use of the ECG devicestarts when the patient experiences symptoms 104. If the patient is notfamiliar with using the device and the overall process 106, 108, thepatient telephones the hospital 110 to acquire step by step instructionsonce symptoms appear. It is believed that some patients will need thisservice, while others will not. While all patients will receiveinstructions when they acquire the ECG device, it is understandable thatonce the patient begins to experience the symptoms of ischemia, thepatient may become less likely to remember the steps and the process.Also, first time users may feel the need to be given step by stepinstructions by human interaction.

Once this call is initiated 110, a trained clinician will instruct thepatient 112 on attaching the electrodes 114 and activating the ECGdevice 116. At this time the process becomes automated. The ECG signalsare then acquired 118 and transmitted to the centralized facility 120.Alternatively, if the patient is familiarized with the apparatus and theprocess 106, 122, the patient attaches the electrodes 124 and activatesthe ECG device 126, which then begins to acquire the ECG signals 118from the patient at a location remote from the health care facility. TheECG device then automatically transmits the ECG signals, or theprocessed ECG data 120 to the centralized facility, as will be furtherdescribed with reference to FIGS. 3-5. It is noted that the ECG devicecan transmit either raw ECG signals to be processed later, or it canprocess the ECG signals and transmit the results of the multi-channelECG.

The centralized facility then receives the ECG signals or the ECGprocessed data 128, and the signals/data are processed at 130. Theprocessing can include either processing the raw ECG signals to producea graph of the ECG, or simply decoding the transmitted processed ECGdata. The trained clinician then analyzes the ECG 132, and if it isclear that there is no cardiac cause for the symptoms 134, 136, theclinician can rule out a cardiac cause for this particular episode 138.The clinician then reassures the patient 140, prints the ECG graph forthe patient's file 142 and instructs the patient to disconnect theelectrodes 144. The ECG device is then disabled and the process is endedat 146.

However, if the clinician suspects a cardiac cause for the symptoms thepatient is experiencing 134, 148, the clinician can re-evaluate the ECGgraph 150 and print the graph 152 for the patient's file whilesimultaneously activating an automatic repeat feature of the ECGactivation and transmission at 154. The clinician then analyzes the newECG 156 and determines if the cause is cardiac related and if care isneeded 158. If the cause is determined not to be cardiac after furtherECG acquisitions 158, 160, the clinician can rule out a cardiac cause138, reassure the patient 140, print and file the ECG 142 and instructthe patient to disconnect the electrodes 144 to end the process 146. Onthe other hand, if the cause is determined to be cardiac related 158,162, the clinician determines whether or not critical care is needed164. If it is not 166, the clinician instructs the patient to go to thepatient's health care facility 168. The process then concludes with thepatient going to the health care facility 170, 146. Conversely, if it isdetermined that critical care is necessary immediately 164, 172, thecentralized facility dispatches an ambulance 174 to pick up the patientand the system continues to monitor the ECG of the patient at 176 untilthe patient arrives at the hospital 178, which concludes the process146.

FIG. 3 shows a block diagram of one embodiment of the present inventionin which a patient 180 is located at a remote location 182. The patient180 is shown connected to the portable ECG device 184, of the presentinvention to receive multiple channels of ECG signals from patient 180.The ECG device 184 is coupled to automatically communicate with awireless communication device, in this case, a cellular or digitalmobile phone 186. The mobile phone 186 is connected to the ECG device184 to receive patient ECG data and to transmit the patient ECG datathrough electromagnetic waves 188 to a centralized health care facility190. In this manner, both voice 192 and ECG signals 194 can becommunicated in real time, or in very near real time, from the remotelocation 182 by electromagnetic waves 188 to the centralized health carefacility 190. This transmission, occurring over a single connection, isdefined herein as being a concurrent voice and ECG data transmission.The wireless phone 186 can be constructed integral with the ECG device184, or it can include infrared transmitter and receivers to communicatetherebetween.

The centralized health care facility 190 may be a hospital, a healthcare provider, or a separate centralized facility providing a service ofmonitoring and assessing the ECG results for hospitals and health careproviders and transmitting the results to the hospital or health careprovider 196 through a data line 197. At the centralized facility 190, alocal communication interface 198 includes a phone connection to allowvoice transmissions 200 with a doctor/clinician 202, who has access tothe patient's file or chart 204. The local communication interface 198is also connected to an ECG and/or an ECG display 206 to process and/ordisplay an ECG graph. The ECG/display 206 is connected to a printer 208so that the ECG graph can be printed and placed in the patient's file204. The file 204 may be an electronic chart accessible to thecentralized facility 190 and/or a separate health care provider 196 viadata line 197. Similarly, the doctor/clinician may communicate directlywith the health care provider 196 to alert the health care provider ofthe results of the ECG. In accordance with the aforementioned process,the doctor/clinician 202 can talk with the patient 180 and observe thepatient's ECG waveforms in real time, or in near real time, to assessthe patient's condition. FIG. 3 shows one particular embodiment fordividing the functions between a centralized facility 190 and a healthcare provider 196, however, it is contemplated that multiple differentconfigurations can be arranged, each of which are embodied in theappended claims.

Referring to FIG. 4, a second embodiment of the present invention isdisclosed. Again, patient 180 is connected to the ECG device 184, of thepresent invention, which preferably includes a 12-channel ECG device,such as the aforementioned GE Marquette MacVu or Seer-MC equipped with12SL™. However, in this embodiment, the wireless communication device isan interactive Internet appliance such as an interactive Web TVappliance 210, capable of allowing voice, video and ECG datatransmission through an interconnected global computer system, such asthe Internet 212. The ECG device 184 and the Web TV appliance 210transmits data therebetween through an infrared transmission 214.Accordingly, the ECG device 184 is equipped with an infrared transmitterand the Web TV appliance is equipped with an infrared receiver, asdescribed with reference to FIG. 1. The Web TV appliance 210 can alsoreceive data instructions from the centralized facility or health careprovider 190 through the Web TV appliance 210. The Web TV appliance 210is connected to a television 216 to display visual signals 218 and audiosignals 220 to patient 180.

Preferably, the Web TV appliance 210 is equipped with a video camera 222and a microphone 224 to receive and transmit audio and video signalsfrom patient 180 to the centralized facility 190. In this manner, theprocessor in the ECG device 184 is programmed to allow concurrenttransmission of ECG data, voice data, and video data, wherein the videoand audio transmissions may be bi-directional. That is, since the voice,video, and ECG signals are communicated in real time, or near real time,from the remote location 182 to the centralized facility 190, which maybe a hospital, the centralized facility 190 is thereby equipped with aWeb computer 226 that is, in turn, connected to a television 228, alsoequipped with a microphone 230 and a video camera 232 to transmit imagesand audio from a doctor or clinician 240. Similar to the embodiment ofFIG. 3, the doctor or clinician at the centralized facility 190, FIG. 4,can listen to and talk to the patient 180 remotely while observing thepatient's ECG waveforms. Also similar to the embodiment of FIG. 3, theECG/display 206 receives data from the local communication interface226. If the data has already been processed, it can go directly to theprinter 208, or if the ECG of the centralized facility is processing thedata, the signals go through the ECG 206, then to the printer 208. Thepatient's file is then updated 204.

Referring to FIG. 5, a detailed flow chart of the software programmedinto the portable ECG device is shown. Once the ECG is initiated 250,the program checks to see if the patient requests assistance with usingthe ECG device 252. If so 254, the auto-dial feature of the mobile phoneis initiated or the Web TV interface is prompted 256, at which timecommunication is permitted between the health care provider, orcentralized facility, and the patient 258. Once the assistance iscomplete 260, or the patient did not require assistance 252, 262, theECG signals are acquired 264, processed 266, and prepared fortransmission at 268. The desired mode of transmission is then selectedat 270 to allow concurrent transmission of ECG data and at least voicecommunication.

If the Web TV mode is selected 270, 272, the ECG transmits the data tothe Web TV device 274 and allows audiovisual communication 276.Conversely, if the wireless phone transmission mode is selected 270,278, the auto-dial feature is enabled, if not already connected 280, andthe ECG transmits the data at 282, thereby allowing bi-directional voicecommunication 284. At this point, regardless of whether the wirelessphone transmission mode is selected 278 or the Web TV mode is selected272, the ECG device is enabled to receive instructions 286 from thecentralized facility. If the ECG is instructed to acquire more data 288,290 the process is repeated. If not 288, 292, the ECG subroutine iscomplete 294.

Accordingly, the present invention includes an ECG monitoring systemhaving a remote ECG monitor with multiple leads and multiple channels toacquire ECG signals from a patient. A remote communication interface isalso provided to receive the ECG signals from the remote ECG monitor andtransmit the ECG signals over a public communication system to a healthcare provider or centralized facility. A local communication interfaceis provided at the centralized facility to receive ECG signals from thepublic communication system and is connected to a local ECG device toreceive the ECG signals and provide the ECG signals in human discernableform. The ECG signals can be processed and digitally analyzed in eitherthe remote ECG monitor, the remote communication interface, the localcommunication interface, or the local ECG device. As previouslydiscussed, the remote communication interface can either be a wirelessphone or an interactive Internet appliance having a video camera ormicrophone to allow bi-directional communication between the patient andthe health care provider. Although it may be considered redundant, anembodiment may include both.

The device can also include an information management system thatincludes a data link port connectable to maintain ECG monitoring duringpatient transport to a health care facility. The information managementsystem can include a portable computer with data storage that isdownloadable at the health care facility for recording the ECG dataduring transit. The information management system includes acommunication system to broadcast ECG data as the patient is in transitto a health care facility.

The invention also includes a method of remotely monitoring ECG datafrom a patient that includes providing an ECG device to a patientexperiencing symptomatic ischemia for use remotely from a health carefacility. The ECG device includes the aforementioned communicationcapabilities to transmit ECG signals/data to a centralized facility. Themethod includes acquiring a multi-channel ECG from the patient at alocation remote from a health care facility and transmitting themulti-channel ECG data to the centralized facility. After assessing themulti-channel ECG at the centralized facility, the method includesproviding instructions to the patient based on the assessment. Themethod can also include offering remote interactive assistance in theuse of the ECG device, if requested by the patient.

It is contemplated that the method can be conducted by a centralizedfacility as a service to a health care facility. That is, personnel atthe centralized facility can coordinate the ECG monitoring and advisethe health care facility as needed. Alternatively, the centralizedfacility can be integrated with the health care facility. The methodalso includes repeating the acquiring, transmitting, and assessingsteps, as dictated by the centralized facility, or health care provider,and if an ECG assessment results in a determination that immediatemedical care is needed, the method includes dispatching emergencypersonnel to the patient. The method can include continuing, acquiring,transmitting, and assessing the ECG while the patient is in transit tothe health care facility.

With the use of a Web TV appliance, the centralized facility can berelatively assured that the patient is located at the patient's houseduring use. However, the same cannot be said for the wireless phonetransmission mode. In this instance, the method can include confirming alocation of the patient before dispatching emergency personnel. This canbe done through telephone communication, but if the patient shouldexperience a heart attack and become unconscious, an alternative methodmust be provided. In this instance, the confirmation step includesreceiving a GPS guidance signal from the ECG device indicative of thelocation of the patient. Accordingly, the ECG device optionally includesa GPS guidance system. The guidance system is initialized by thecentralized facility which sends the GPS initialization signal to theECG device, and once received, the ECG device transmits a GPS guidancesignal from the ECG device to a global satellite system, which in turn,transmits a location of the patient to the centralized facility.

The present invention has been described in terms of the preferredembodiment, and it is recognized that equivalents, alternatives, andmodifications, aside from those expressly stated, are possible andwithin the scope of the appending claims.

1-35. (canceled)
 36. A cardiac condition monitoring system comprising: apatient ECG monitor having a plurality of ECG leads connectable theretoand configured to acquire ECG signals from a patient; a patientcommunication interface constructed to receive the ECG signals from thepatient ECG monitor and transmit the ECG signals to a health careprovider during a patient diagnosed cardiac event; and a controllerconnected to the patient ECG monitor and constructed to initiateoperation of the patient ECG monitor upon receiving a command from thepatient experiencing the patient diagnosed cardiac event and cease anyoperation of the patient ECG monitor upon a confirmation ofnon-criticality of the patient diagnosed cardiac event.
 37. The systemof claim 36 further comprising a health care communication interfaceconstructed to communicate with the patient communication interface andreceive at least one of the acquired ECG signals and ECG signalsconverted into a human discernable form.
 38. The system of claim 37wherein the patient ECG monitor wirelessly communicates with the patientcommunication interface and the patient communication interfacewirelessly communicates with the health care communication interface.39. The system of claim 36 wherein the patient communication interfaceis constructed to concurrently communicate at least two of the ECGsignals, ECG signal converted to a human discernable form, and a movingvideo signal to a health care provider communication interface.
 40. Thesystem of claim 36 wherein initiated operation of the patient ECGmonitor further comprises the patient attaching the plurality of leadsof the patient ECG monitor to the patient and ceasing any operation ofthe patient ECG monitor further comprises disconnecting the plurality ofleads of the patient ECG monitor from the patient and turning off theECG monitor.
 41. The system of claim 36 further comprising aninformation storage system having a port thereon and connected to thepatient ECG monitor, the information storage system constructed to storethe acquired ECG signals and the port constructed to be directlyconnected to a health care provider ECG system to allow the transmissionof the stored ECG signals therefrom.
 42. An ECG monitoring systemcomprising: a ECG monitor constructed to acquire ECG signals from apatient and communicate the ECG signals to a health care provider, theECG monitor designed and constructed for only intermittent use by thepatient when the patient decides of an onset of a possible cardiacevent, at which time the ECG monitor is activated by the patient,otherwise the ECG monitor remains inactive.
 43. The system of claim 42wherein the ECG monitor further comprises a plurality of leads toacquire ECG signals from the patient and activation of the ECG monitorincludes applying the plurality of leads to the patient.
 44. The systemof claim 42 further comprising a remote communication interfaceconfigured to communicate with the ECG monitor when the ECG monitor isactivated, the remote communication interface configured to communicatewith a health care facility communication interface.
 45. The system ofclaim 44 wherein the remote communication interface is connected to theECG monitor and includes a data storage device to store the ECG signalssuch that the ECG signals are at least one of transmitted to health carefacility communication interface as the ECG signals are acquired andstored in data storage device until the data storage device is connectedto the health care facility communication interface.
 46. The system ofclaim 42 wherein the ECG monitor further comprises a GPS systemconnected thereto and constructed to be remotely actuated by a signalfrom the health care provider.
 47. The system of claim 42 wherein theECG monitor is further configured to prompt the patient if assistance isneeded when the ECG monitor is activated, and if so, establishcommunication with the health care facility, otherwise, at least one of,transmit acquired ECG signals to the health care provider and store ECGdata when transmission is impossible.
 48. The system of claim 42 furthercomprising a first communication interface constructed to wirelesslycommunicate with the ECG monitor, a second communication interfaceremotely positioned from the first communication interface andconstructed to wirelessly communicate therewith, and a health careprovider ECG device configured to communicate with the secondcommunication interface and provide the ECG signals in human discernableform.
 49. An ECG monitor system comprising: a remote ECG monitor havingmultiple leads and multiple channels to acquire ECG signals from apatient, and a data storage device to store the ECG signals; a remotecommunication interface to receive the ECG signals from the remote ECGmonitor and transmit the ECG signals over a public communication systemto a centralized facility; a local communication interface to receiveECG signals from the public communication system at the centralizedfacility; and a local ECG device connected to the local communicationinterface to receive the ECG signals and provide the ECG signals inhuman discernable form and a data port connectable to the data storagedevice of the remote ECG monitor to allow direct transfer of datatherebetween.
 50. The system of claim 49 wherein the remote ECG monitorincludes an infrared transmitter to transmit the ECG signals to theremote communication interface and wherein the ECG signals are processedand digitally analyzed in at least one of the remote ECG monitor, theremote communication interface, the local communication interface, andthe local ECG device.
 51. The system of claim 49 wherein the remotecommunication interface is one of (1) a wireless phone, and (2) aninteractive Internet appliance having a video camera and microphone toallow bi-directional communication between the patient and thecentralized facility.
 52. The system of claim 51 wherein the wirelessphone is integral with the remote ECG monitor and is preprogrammed witha telephone number of the centralized facility.
 53. The system of claim49 further comprising a GPS system connected to the remote ECG monitorand configured to receive a signal from the centralized facility toenable the GPS system.
 54. The system of claim 49 wherein the remote ECGmonitor includes a processor programmed to: prompt the patient ifassistance is needed to acquire an ECG, and if so, open a datatransmission link to the centralized facility; otherwise, receive andprocess the ECG signals, then open a data transmission link and transmitthe ECG data to the centralized facility.
 55. The system of claim 54wherein the data storage device includes an information managementsystem, the information management system is at least one of configuredto maintain ECG monitoring during patient transport to a health carefacility and includes a processor and a communication system tobroadcast ECG data as the patient is in transit to a health carefacility.